O consentimento informado consiste em um processo capaz de informar o participante de pesquisa sobre as intervenções médicas previstas a serem aplicadas no decorrer do estudo e faz com que este participe ativamente no processo de tomada de decisão. O Termo de Consentimento Livre e Esclarecido (TCLE) caracteriza-se por ser um documento explicativo, de forma escrita, no qual são abordadas informações referentes ao projeto de pesquisa, com o objetivo de garantir a voluntariedade do indivíduo. A qualidade do TCLE em pesquisa clínica é determinada pelo grau de compreensão que os participantes desenvolvem durante o processo de consentimento informado. O objetivo deste estudo consiste em avaliar o processo de consentimento dos participantes de pesquisa clínica. Trata-se de um estudo híbrido, com coleta prospectiva. Para o seu desenvolvimento dividiu-se nas seguintes fases: Elaboração e validação do formulário, Treinamento da Equipe de Entrevistadores, Estudo Piloto, Coleta de Dados e Avaliação da Legibilidade dos TCLEs. Foi realizada análise descritiva dos dados e comparação entre as variáveis por meio de análises univariadas. Dos 70 participantes que compuseram a amostra, 83% eram mulheres, a média de idade foi de 46,7 anos (S ±13.99 anos), 55,7% eram brancos, 45,75% casados, 52,9% analfabetos ou com ensino fundamental, 49,3% economicamente ativos e renda média de 1496,2 reais. Dos participantes, 35,7% desconheciam o tipo de estudo que participavam 38,6% não sabiam contar sobre a pesquisa que participavam, 64,7% não receberam informações referentes a outros tipos de tratamento, 62,7% não tinham informações sobre indenização, 66,2% não leram todo o TCLE antes de assinar, 86,8% relataram que o documento foi fácil de ser lido, 62,2% acharam o documento longo. Após o cálculo do ILFK dos 12 TCLEs analisados, 100% apresentaram valor de 0 a 30, considerado como leitura muito difícil. É de suma importância incentivar o desenvolvimento de estudos nacionais que avaliem a percepção dos participantes de pesquisa quanto aos seus direitos e a criação de instrumentos que possibilitem essa verificação na população brasileira / Informed consent consists a process that is able to inform, the research participant, of the planned medical interventions to be apply during the course of the study, and actively participate in the decision-making process. The Informed Consent Form (ICF) characterized by being an explanatory document, in written form, in which information about the research project is addressed, with the purpose of guaranteeing the individual\'s willingness. The quality of ICF in clinical research determined by the degree of understanding that participants develop during the informed consent process. The objective of this study is to evaluate the consent process of clinical research participants. It is a hybrid study, with prospective collection. For its development, it divided into the following phases: Elaboration and validation of the form, Training of the Team of Interviewers, Pilot Study, Data Collection and Evaluation of the Readability of ICF. A descriptive analysis of the data and a comparison between the variables performed using univariate analyses. Of the 70 participants, 83% were women, mean age was 46,7 years (S ± 13.99 years), 55,7% were white, 45,75% married, 52,9% illiterate or basic education, 49,3% economically active and average income of 1496,2 Reais. Of the participants, 35,7% didn\'t know the type of study they participated in, 38,6% didn\'t know about the research they participated, 64,7% didn\'t receive information regarding other types of treatment, 62,7% didn\'t have information about compensation, 66,2% didn\'t read the entire ICF before signing, 86,8% reported that the document was easy to read, 62,2% found the document long. After the ILFK calculation of the 12 ICF analysed, 100% presented values from 0 to 30, considered as very difficult reading. It is extremely important to encourage the development of national studies that evaluate the perception of research participants regarding their rights and the creation of instruments that enable such verification in the Brazilian population

Made available in DSpace on 2016-03-15T19:39:45Z (GMT). No. of bitstreams: 1 Tania Medeiros Aciem.pdf: 496194 bytes, checksum: 579716592317299a9aa3a2724ee0a206 (MD5) Previous issue date: 2011-08-16 / This study aims to identify the contribution of specialized institutions as the personal and social autonomy of visually impaired people (blindness) after going through rehabilitation services, more than four hours a week, a minimum of two years, between the years 2002 to 2009. Study subjects are visually impaired people (blindness), who went through rehab, and their family members who accompanied the process. It is a research project with qualitative approach, by organizing interviews and questionnaires to collect data on social autonomy and personal independence of people with visual impairments. The study involved the six people with visual impairments, and six family members, one member to each person with visual impairment. The survey results indicate that rehabilitation alternatives provided for determining changes to people with visual impairments in their social context. The conquest or reconquest of personal and social autonomy of this population was reached, providing thus a better quality of life. / Este estudo visou identificar a autonomia pessoal e social de pessoas com deficiência visual (cegueira) após passarem por serviços de reabilitação, com mais de quatro horas semanais, num período mínimo de dois anos, entre os anos de 2002 a 2009. Foram sujeitos deste estudo pessoas com deficiência visual (cegueira), que passaram pela reabilitação, e os respectivos familiares que acompanharam o processo. Foi uma pesquisa com enfoque qualitativo, através da organização de questionários e entrevistas para a coleta dos dados. O estudo envolveu seis pessoas com deficiência visual, além dos seis familiares, correspondendo um para cada pessoa com deficiência visual. Os resultados da pesquisa indicam que a reabilitação proporcionou alternativas para mudanças determinantes às pessoas com deficiência visual em seu contexto social. A conquista, ou a reconquista da autonomia pessoal e social dessa população foi alcançada, propiciando, consequentemente, uma melhor qualidade de vida.

Abstract The potential health effects of employee control over working times are poorly known in the field of work stress research. In this study, worktime control was hypothesized to buffer against stress by promoting successful combination of a full-time job with non-work demands and by enabling the work to be done at times of optimal resources. The participants were from the 10-Town Study, an ongoing longitudinal cohort study exploring employee health in ten Finnish towns. The survey responses on worktime control and health (baseline survey in 1997: n = 6442, 67%; follow-up survey in 2000–01: n = 32299, 67%) were linked to registered sickness absences from the employers' records. Employee worktime control covered the perceived possibilities to influence the starting and ending times of a workday, the breaks, handling private matters during the workday, the scheduling of shifts, vacations and days off, and the taking of unpaid leaves, each of which was rated on a 1–5 scale. In the follow-up survey, influence on the length of the workday was also assessed. After a factor analysis, the subdimensions of control over daily working hours and control over days off were focused. It turned out that low worktime control predicted poor subjective health, psychological distress, and medically certified sickness absences for women. For men, low worktime control was not associated with subjective health, but predicted medically certified sickness absences for those with dependent children or employed in manual occupations. With respect to work stress, the men and women suffering from job strain or effort-reward imbalance had less medically certified sickness absences if they at least had control over their working times. The men and women with long domestic and total working hours and long commuting hours gained most from high worktime control in that their medically certified sickness absences were reduced. Vulnerability to long domestic and total working hours in terms of such absences was seen among both men and women, but there were few men working long domestic hours. Long paid working hours as such were not associated with sickness absences. In sum, high worktime control appeared to buffer against health problems and to promote a successful integration of domestic responsibilities with a full-time job. The findings expand the focus of work stress research and emphasize the importance of taking conditions at home into account when analysing employee health. / Tiivistelmä Työaikojen hallinnan merkitys terveydelle tunnetaan työstressitutkimuksen alalla huonosti. Tässä väitöskirjatyössä oletettiin, että työaikojen hallinta voisi vähentää stressiä ja edistää terveyttä helpottamalla kokopäivätyön ja kotona tehtävän työn yhteensovittamista sekä mahdollistamalla työn tekemisen parhaiden voimavarojen vallitessa. Tutkimus toteutui osana Työterveyslaitoksen Kunta10 -tutkimusta, joka seuraa kymmenen suomalaisen kaupungin henkilöstön työolojen ja terveyden kehittymistä. Koettua työaikojen hallintaa ja terveyttä koskevat kyselyvastaukset (alkukysely v. 1997: n = 6442, 67 %; seurantakysely vv. 2000–01: n = 32299, 67 %) linkitettiin palkanmaksurekistereistä saatuihin sairauspoissaolotietoihin. Työaikojen hallinnan mittari sisälsi alkukyselyssä 5-luokkaisella asteikolla vastaajien kokemat vaikutusmahdollisuudet työpäivän alkamis- ja päättymisajankohtiin, taukoihin, yksityisasioiden hoitamiseen työpäivän kuluessa, työvuoroihin, lomien ja vapaapäivien ajankohtiin sekä palkattomien vapaiden pitämiseen. Seurantakyselyssä kartoitettiin myös vaikutusmahdollisuudet työpäivän pituuteen. Summamuuttujan faktorianalyysin jälkeen arvioitiin erikseen päivittäisten työaikojen hallintaa sekä loma-aikojen hallintaa. Tuloksissa huono työaikojen hallinta ennusti naisilla huonoksi koettua terveyttä, psyykkistä rasittuneisuutta sekä lääkärintodistusta vaativia yli kolmen päivän mittaisia sairauspoissaoloja. Miehillä huono työaikojen hallinta ei vaikuttanut itsearvioituun terveyteen, mutta ennusti lääkärintodistusta vaativia sairauspoissaoloja, jos heillä oli lapsia kotona tai jos he tekivät ruumiillista työtä. Hyvä työaikojen hallinta vähensi työstressiin liittyviä sairauspoissaoloja. Stressiä kuvattiin työn kovien vaatimusten ja huonon hallinnan yhdistelmällä sekä koettujen ponnistelujen ja palkkioiden epäsuhdalla. Eri elämänalueilla tehtyihin työtunteihin suhteutettuna hyvä työaikojen hallinta vähensi sairauspoissaoloja erityisesti niillä naisilla ja miehillä, joilla oli paljon kotityötunteja, työmatkatunteja tai totaalityötunteja. Sairauspoissaoloilla mitattuna naiset ja miehet olivat yhtä haavoittuvia pitkille kotityö- työmatka- ja totaalityötunneille, mutta miehillä pitkät kotityötunnit olivat harvinaisia. Pitkät palkkatyötunnit sinänsä eivät lisänneet sairauslomia. Tutkimus tuo työstressikirjallisuuteen vallitsevia malleja täydentävää tietoa työn ulkopuolisten tekijöiden merkityksestä työntekijöiden terveydelle. Tulokset kannustavat edistämään työntekijöiden mahdollisuuksia työaikojensa hallintaan sekä terveyden edistämisen että kokopäivätyön ja muun elämän menestyksellisen yhdistämisen näkökulmista.

La révolution de 1789 fit émerger, face à une société jusqu’alors conçue comme une entité, un nouvel individu désireux d’affirmer sa singularité. À la morale chrétienne qui se réfère à Dieu, les philosophes du XVIIIe siècle, et plus particulièrement Kant, ont voulu substituer une morale où l’homme serait, selon le mot de Protagoras, mesure de toutes choses. Cependant, l’individu devait encore se conformer à ce que Kant nomme l’impératif catégorique, et supporter une adhésion forcée à des valeurs communes. La morale a été progressivement ressentie comme autoritaire et illégitime ; certains ont voulu ne voir en elle que les valeurs d’une société bourgeoise. Les années 1960 donnèrent donc naissance à une morale individuelle, qui a pris le nom d’éthique. Ces bouleversements n’ont pas été sans répercussions profondes sur le droit des personnes et de la famille. Aussi les bonnes moeurs ont-elles disparu du droit de la famille pour laisser la place en droit des personnes à la dignité humaine : à la conception d’un droit-modèle succéda celle d’un droit-principe. La notion de dignité ne fut consacrée dans le Code civil français que fort tardivement, ce qui explique l’absence de consensus concernant sa définition. On peut regretter qu’une telle fragilité ait pu entraîner la dilution de ce principe, voire sa transformation en un droit subjectif ; elle n’oppose alors qu’une faible résistance à l’avènement de l’autonomie personnelle, construite en porte-à-faux par la Cour européenne des droits de l’homme sur l’article 8 et le consentement de l’individu. Dans cette sphère européenne, l’individu a gagné le droit d’opérer des choix sur son corps, quelque dangereux qu’ils soient, et peut-être même la liberté de renoncer au bénéfice des droits énoncés dans la Convention. Il apparaît donc essentiel de redéfinir la dignité, rempart contre la réification de l’être humain, autour des concepts de liberté et d’égalité. Dès lors, d’une logique néfaste de concurrence entre la dignité et l’autonomie, pourra renaître un véritable rapport de complémentarité et de hiérarchie / After the French revolution, in front of a holist society hitherto, the willingness of a new individual to affirm his singularity did emerge. Whilst the Christian morality referred to God, the XVIIIth century philosophers, especially Kant, wanted to substitute a morality where, according to the words of Protagoras, man would be the measure of anythings. The individual, however, still had to conform to what Kant names the categorical imperative, and to support for shared values. The morality became gradually felt as authoritative and illegitimate, the middle-class values. The 60’s let rise an individual morality, which took the name of ethics. These upheavals were not without major effects on law of persons and family law. Boni mores disappeared therefore from family law to give way to human dignity in law of persons: to the conception of a model law that of a principle law did succeed. The concept of dignity was only tardily devoted in the Civil code: that could explain the absence of consensus concerning its definition. One can consider it regrettable that such a fragility could involve the dilution of this principle, and even its transformation into a subjective right; it does not oppose whereas a low resistance to the advent of personal autonomy, awkwardly built by the European Court of the human rights on the article 8 and the individual consent. The individual gained the right to operate choices on his body, however dangerous they are, and perhaps even freedom to give up the benefit of rights stated in the Convention. It thus appears essential to redefine dignity, a rampart against the reification of human being,around the concepts of freedom and equality. Consequently, from a harmful logic of competition between dignity and autonomy, a true relation of complementarity and hierarchy between these two concepts will be able to reappear.

En France, sous l'impulsion de la loi du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé, des modifications profondes de la relation de soin en faveur d'une participation plus active des patients ont été engagées imposant un repositionnement de chaque acteur de cette relation. La loi précise que l'implication des patients dans les processus de prise de décision doit être recherchée y compris lorsque les patients présentent des limitations de leurs capacités de décision. L'affirmation de ces droits va de pair avec la reconnaissance de capacités de décision aux patients et le développement d'une décision médicale partagée. Elle entraîne néanmoins, lorsque ces capacités sont atteintes, des difficultés concrètes dans le recueil du consentement du patient et/ou de ses représentants légaux et aidants. Il est aujourd'hui reconnu que les besoins en santé orale des patients présentant des limitations durables de leurs capacités de décision sont non satisfaits et augmentés par rapport à la population générale. Ces inégalités de santé résultent de nombreux obstacles dans l'accès aux soins et à la prévention, mais aussi dans la prise en charge, et alors que le principe d'égal accès au soin de tous les citoyens est reconnu comme un fondement juridique national. Cette situation constitue une perte de chance pour ces personnes d'autant plus qu'une santé bucco-dentaire dégradée peut avoir, au-delà des conséquences locales, des répercussions sur la santé générale et plus particulièrement sur la qualité de vie et l'intégration sociale. Ces difficultés cumulées quotidiennement conduiraient donc à privilégier des thérapeutiques symptomatiques sans réflexion de l'ensemble des acteurs autour d'une réhabilitation fonctionnelle globale. Pourtant, il est reconnu que la lutte contre les inégalités de santé passe par le développement d'une prise en charge globale de la santé. S'appuyant sur une participation des différents acteurs et notamment des patients aux prises de décision, celle-ci prévoit un décloisonnement entre les domaines relevant du sanitaire, du social et de l'éducatif pour un continuum par priorité. Ce travail, par une recherche qualitative et participative, a pour objectif d'explorer les raisons des limitations de réponse thérapeutique auprès de chaque acteur de la relation de soin - les patients, les aidants et les chirurgiens-dentistes. Une fois celles-ci mieux comprises, les différentes représentations sont confrontées et les tensions éthiques qui s'y dégagent discutées. Puis, des pistes d'évolution de la prise en charge de la santé orale, et au-delà, des évolutions sociétales sont proposées pour espérer à terme réduire les inégalités de santé. / In France, under the impulse of the Law of 4 March 2002 on patients' rights and the quality of the health system, deep changes have been undertaken in the care relationship for a more active participation of patients. This imposes a repositioning of each individual involved in the relationship. The law specifies that the involvement of patients in decision-making should be sought even when they present limitations of their decision-making abilities. The affirmation of these rights is consistent with the recognition of patients' decision-making abilities and the development of a shared decision. Nevertheless, when the limits of these abilities are reached, it leads to practical difficulties in the consent of patients and/or legal guardians and caregivers. It is now recognized that the oral health needs of patients with enduring limitations of their decision-making abilities are not satisfied, and are increased compared to those of the general population. These health inequities result from many barriers in access to care and prevention, but also during care, and yet the principle of equal access to care for all citizens is recognized as a national legal principle. This situation constitutes a loss of opportunity for these people - especially as, beyond its local impacts, impaired oral health may have impacts on their overall health and particularly on their quality of life and social integration. These limitations, which accumulate day after day, may lead to symptomatic therapies being favoured without concerted thinking on a global functional rehabilitation. Yet it is recognized that the fight against health inequalities requires the development of comprehensive overall health care. This means that, relying on the participation of the different stakeholders including patients in decision-making, the barriers separating areas concerning health, social and educational care have to be abolished for a continuum by priority. The aim of this work is to explore, by qualitative and participatory research, the reasons for the limitations of the therapeutic response from each member of the care relationship - patients, caregivers and dentists. Once these reasons have been better understood, the different representations are considered face to face and the ethical tensions that emerge are discussed. Then, ways in which the management of oral health can be improved and, beyond this evolution, ways in which society could change are proposed with the ultimate hope of reducing health inequalities.

Illich, a critic of the medical profession in industrial societies, researched the "damage done" by the medical establishment on three levels. This study presents an application of Illich's three-level theory of iatrogenesis to a sample of elderly people in old-age homes in and around Pretoria. Fifty in-depth interviews were conducted with old-age home residents. In the focus on clinical iatrogenesis, the aspect of defenceless patients was investigated. With regard to social iatrogenesis, focus was on the interpretation of attitudes revealing an increased medical dependency. Cultural iatrogenesis, which involves the influence of values and norms on thinking patterns, is investigated in terms of the impact of institutionalisation on the autonomy, independence and personal responsibility of residents. Illich's solution to the problem of medicalisation is to be found in the de-bureaucratisation and de-industrialisation of society. Based on the assumptions of critical theory, the emancipation of the individual is suggested as a basis of Illich's proposed structural societal changes / M.A. (Sociology)

Litigation in person is a widespread phenomenon in common law jurisdictions. A right to litigate in person is treated as a fundamental right, regardless of whether the litigant has the financial means to hire a lawyer or the capacity to conduct litigation effectively. Due to the high numbers of litigants in person and the various burdens placed on judicial resources by their lack of legal knowledge, they pose a serious challenge to the effective and efficient administration of justice. This thesis assesses the theoretical value of a right to self-representation, and challenges the position that courts should not impose legal representation on a litigant nor require him to obtain such representation as a condition for litigation. It argues that a litigant who lacks the professional knowledge and skills to present his case effectively cannot legitimately insist upon representing himself if in doing so he is likely to inflict disproportionate costs on his opponent and on the administration of justice. This thesis advances the case for mandatory representation in civil proceedings on three main fronts: a comparison with the criminal context, an assessment of the value of self-representation in terms of outcome, and an examination of its possible intrinsic justifications.

Le concept d'autonomie personnelle est apparu récemment dans l'ordre juridique européen, comme la faculté pour la personne humaine de mener sa vie comme elle l'entend. Ce concept trouve son ancrage dans un système juridique en pleine mutation, tiraillé entre deux traditions, l'une anglo-saxonne qui constitue un modèle autonomique de protection des droits de la personne, et l'autre continentale, plus paternaliste. Le rôle des juges constitutionnels européens et des organes de la Convention européenne des droits de l'homme s'est révélé décisif pour faire émerger la notion d'autonomie personnelle au sein de l'ordre juridique, et pour l'ériger progressivement en principe matriciel des droits fondamentaux. La prise en considération de l'autonomie personnelle vise, en effet, à modifier la protection juridique de la personne humaine, qui n'est plus générale et abstraite mais ajustée et concrète, répondant ainsi aux enjeux actuels de la protection des droits de l'homme et de la réalité sociale.Le but de cette étude est d'analyser la fonction de l'autonomie personnelle, vecteur d'intégration sociale de toute personne humaine, et élément participatif au pluralisme interne essentiel à une société démocratique. L'analyse porte sur les avancées permises par la reconnaissance de l'autonomie personnelle dans la protection des droits individuels et dans ceux des minorités. Malgré certaines réticences doctrinales, cette fonction se révèle limitée dans la remise en cause des valeurs sociales qu'elle pouvait induire, mais elle s'avère primordiale au développement de la protection des droits de la personne humaine. / The concept of personal autonomy recently appeared in the European justice system as a means by which people can lead their lives as they wish. This concept has its roots in an evolving justice system, torn between two traditions: the Anglo-Saxon model of individual rights; and the paternalist Continental approach. The role of constitutional European judges and the inner-workings of the European Convention on Human Rights has proved decisive for the development of the idea of personal autonomy which lies at the heart of the justice system, and its evaluation within the matrix of fundamental rights. Taking into account personal autonomy aims to effectively alter the judicial protection of the rights of the person which is no longer general and abstract but rather concrete and refined, and also addresses current issues of the protection of human rights and the reality of society.The aim of this study is to analyse the function of personal autonomy and the direction of human social interaction and the participative element of internal pluralism which is essential to a democratic society. The analysis focuses on advances permitted by the recognition of personal autonomy in the protection of individual rights and those of minorities. In spite of some doctrinal reluctance, this function proves limited in light of questions regarding social values which it might raise, but it proves essential to the development of the protection of the rights of the person.

Objetivos: Este estudo investigou as associações entre características dos médicos e a variabilidade de condutas em fim de vida em UTI. Métodos: Um questionário foi aplicado aos médicos das 11 UTIs do HC-FMUSP, apresentando dois casos clínicos. O primeiro apresentava uma paciente em estado vegetativo persistente, sem familiares ou diretivas antecipadas de vontade, com um choque séptico. O segundo, uma paciente de 88 anos, com disfunção de múltiplos órgãos decorrente de uma pneumonia. Investigou-se através do questionário a associação entre condutas e características pessoais, profissionais e educacionais dos médicos. Resultados: Foram analisados 105 questionários (taxa de resposta 89%). A media de idade foi de 38±8 anos, com 14±7 anos de graduação em medicina. A maioria das decisões envolveu exclusivamente médicos (66%), 21% envolveram também enfermeiros. Na análise multivariada, especialistas em Medicina Intensiva (17/22 vs. 46/83, OR=0,205[0,058-0,716], P=0,013) e médicos mais jovens (38±7 vs. 40±8; OR=0,926[0,858-0,998], P=0,045) mais frequentemente envolveram enfermeiros no processo de decisão. Ordem de não reanimação (ONR) foi estabelecida por 89% dos participantes, sendo 44% exclusivamente verbais. Médicos que atribuíram a si mesmo notas mais altas em relação ao conhecimento sobre cuidados paliativos mais frequentemente estabeleceriam uma ONR na análise multivariada (6±2 vs. 3±2, OR=2,167[1,062-4,420], P=0,034). A maior parte dos participantes (60%) respondeu que limitaria de alguma forma o suporte artificial de vida (SAV) para a primeira paciente, enquanto 21% respondeu que não limitaria nenhum suporte e 19% retiraria o SAV. Na análise de regressão logística, o interesse em discutir sobre fim de vida em UTI permaneceu como variável de associação independente para retirada ou limitação de SAV (20/20 vs. 61/63 vs. 17/22, OR=0,129[0,019-0,894], P=0,038). Quarenta e seis dos 105 médicos avaliados (44%) apresentavam respostas discordantes para as questões sobre a conduta mais provável e a conduta acreditada como a melhor para a primeira paciente. Dentre estes, 45 (98%) acreditavam que a melhor conduta envolveria o uso de menos SAV do que provavelmente fariam. Motivos relacionados a aspectos jurídicos ou legais foram os mais frequentemente apontados como os motivos para a divergência entre estas condutas. A maioria das decisões (58%) envolvendo uma paciente octagenária lúcida na UTI com alto risco de morte ou de baixa funcionalidade em caso de sobrevivência foram decisões paternalistas, e não ofereceram qualquer autonomia à paciente ou a sua família. A análise multivariada observou que médicos mais jovens (39±8 vs. 41±8, OR=0,966[0,9390,994], P=0,016) e que leram mais artigos sobre fim de vida ou cuidados paliativos em UTI (15/44 vs. 12/61, OR=2,404[1,0185,673], P=0,045) estavam associadas de forma independente ao compartilhamento da decisão com a paciente e/ou sua família, provendo assim algum grau de autonomia. Conclusão: Características dos médicos que trabalham em UTIs como idade, interesse e educação em cuidados paliativos em UTI se associam a variabilidade de condutas em fim de vida em UTI. Quarenta e quatro por cento dos médicos investigados não agiriam conforme o que julgam melhor para a paciente, utilizando-se de mais SAV do que julgam melhor. Motivos legais foram os mais citados como a causa desta discrepância de condutas / Purpose: To investigate associations between physician education in end-of-life (EOL) care and variability in EOL practice in the ICU, and differences between actual EOL practice and what physicians believe is best for the patient. Methods: Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, and physicians personal, professional and EOL educational characteristics. Results: One-hundred-and-five questionnaires were analyzed (response rate 89%). Respondents mean age was 38±8 years, with a mean of 14±7 years post-graduation. Physicians who applied written do-not-resuscitate (DNR) orders had more often attended EOL classes than those who did not apply DNR orders (31/47 vs. 0/7, OR=1.818[1.456-2.159], P=0.001). Younger physicians (38±7 vs. 40±8 years, OR=0.926[0.858-0.998], P=0.045) and ICU specialists (17/22 vs. 46/83, OR=0.205[0.058-0.716], P=0.013) more often involved nurses in EOL decision-making than did other physicians. Physicians who would withdraw lifesustaining therapies had more often read about EOL (11/20 vs. 3/22, OR=1.306[1.0011.547], P=0.012) and had more interest in discussing EOL (20/20 vs. 17/22, OR=4.717[2.0487.381], P<0.001), than physicians who would apply full code. Forty-four percent of respondents would not do what they believed was best for their patient: 98% of them believed a less aggressive attitude was preferable with legal concerns the leading cited cause for this dichotomy. Conclusions: Physician education about EOL issues is associated with variability in EOL decisions in the ICU. Actual practice may differ from what physicians believe is best for the patient

Estudo do tipo metodológico com abordagem psicométrica que lida com a teoria e desenvolvimento de instrumentos de medição. O percurso metodológico norteou-se nos procedimentos teóricos, empíricos e analíticos para a elaboração de instrumento psicométrico (PASQUALI, 1998), e fundamentou-se em duas teorias da privacidade (WESTIN, 1970; ALTMAN, 1975), na teoria da territorialidade (ARDREY, 1966) e na teoria proxêmica (HALL, 1986). Os procedimentos teóricos compreenderam a definição do construto privacidade física no contexto hospitalar, em especial a exposição e manipulação corporal, o qual delineou-se a partir do referencial teórico adotado, da literatura pertinente e de estudo junto a 34 pacientes internados nos hospitais de Maringá-PR, com abordagem qualitativa, utilizando-se a análise de conteúdo (BARDIN, 2000). Esse estudo permitiu descrever a percepção do paciente hospitalizado sobre a privacidade em geral e sobre a privacidade física, identificando-se três categorias empíricas referentes à privacidade em geral, a saber, dignidade e respeito, espaço pessoal e territorial e autonomia, e com relação à privacidade física extraíram-se iguais categorias, acrescentando-se às anteriores a categoria intimidade e toque. Tais categorias compuseram os quatro domínios do instrumento em construção. O instrumento foi submetido à análise semântica e conceitual por um painel de juízes composto por sete peritos, e na seqüência a um pré-teste junto à população-alvo, resultando em um instrumento com 22 itens, tendo o domínio dignidade e respeito 8 itens, intimidade e toque e espaço pessoal e territorial 5 itens cada, e o domínio autonomia 4 itens. Os procedimentos empíricos englobaram a aplicação do instrumento construído, Escala de Satisfação do Paciente Hospitalizado com sua Privacidade Física (ESPH-PF), a uma amostra de 254 pacientes internados na rede hospitalar de Maringá- PR, entre novembro de 2007 e fevereiro de 2008. Os procedimentos analíticos englobaram a análise da consistência interna ( de Cronbach total de 0,68 e variação entre 0,35 e 0,60 nos domínios) e a validade de construto por meio da análise fatorial, extraindo-se seis fatores (57,6% da variância total) e optando-se por manter os quatro pré-estabelecidos (47,7% da variância explicada). A validade convergente do construto utilizando-se a correlação produtomomento de Pearson (p < 0,01) e aplicação da Escala do Sentimento frente à Invasão do Espaço Territorial e do Espaço Pessoal do Paciente Hospitalizado (EMS-FIETEP), contemplou o domínio espaço pessoal e territorial da ESPH-PF e confirmou o poder discriminativo de todos os 22 itens do instrumento. A validade discriminante do construto empregando o teste t de student (p < 0,05) não encontrou diferença estatística significante, exceto nos grupos extremos relativos à escolaridade. A análise psicométrica demonstra que a ESPH-PF pode ser aplicada para medir a satisfação do paciente com sua privacidade física no contexto hospitalar, sobretudo no que diz respeito à exposição e manipulação corporal. Os resultados obtidos junto a essa população não podem ser generalizados, porém comprovam a importância de se avaliar a satisfação do paciente com sua privacidade física, visto que o nível de satisfação revela, implicitamente, as preferências e necessidades dele por privacidade, e indiretamente também reflete o desempenho dos profissionais de saúde relativo à proteção e manutenção da privacidade no hospital. / The study is of a methodological type using the psychometric approach which deals with the theory of the development of measurement instruments. The methodological apparatus is based on empirical and analytical theoretical proceedings, to the development of a psychometric instrument (PASQUALI, 1998), and is grounded in two privacy theories (WESTIN, 1970; ALTMAN, 1975), on the territoriality theory (ARDREY, 1966) and on the proxemic theory (HALL, 1986). The theoretical proceedings entailed the definition of the physical privacy construct in hospital context, especially the exposure and body manipulation, drawing on the theoretical apparatus used, the related literature and a study with thirty-four patients admitted in hospitals in Maringá-PR, with qualitative approach, using the content analysis (BARDIN, 2000). This study allowed to describe the perception of the hospitalized patient as regards general privacy and physical privacy, identifying three empirical categories concerning general privacy, namely dignity and respect, personal and territorial space and autonomy, and as regards physical privacy the same categories were extracted, adding to the previous ones the category of intimacy and touch. Such categories composed the four domains of the instrument under construction. The instrument was subjected to semantic and conceptual analyses by a panel of judges composed by seven connoisseur, followed by a pretest with the target population, resulting in an instrument with 22 items, in which the domain dignity and respect had eight items, intimacy and touch and personal and territorial space had five items each, and the domain autonomy had four items. The empirical proceedings entailed the application of the constructed instrument, Satisfaction Scale of the Hospitalized Patient with his/her Physical Privacy (ESPH-PF), to a sample of 254 patients admitted in the hospital chain of Maringá-PR between November 2007 and February 2008. The analytical proceedings entailed the internal consistency analysis (-Cronbach total of 0,68 variation between 0,35 and 0,60 in the domains) and the construct validity by means of factorial analysis, extracting six factors (57,6% of total variation) and opting to maintain the four preestablished ones (47,7% of explained variation). The convergent validity of the construct utilizing the correlation product-moment of Pearson (p < 0,01) and the application of Feeling Scale before the Invasion of Territorial and Personal Space of the Hospitalized Patient (EMSFIETEP) contemplated the domain personal and territorial space of ESPH-PF and confirmed the discriminating power of all 22 items of the instrument. The discriminating validity of the construct employing the test t of student (p < 5005) did not find significant statistical difference, except for extreme groups regarding education. The psychometric analysis shows that the ESPH-PF can be applied to measure the patients satisfaction with his/her physical privacy, once the level of satisfaction implicitly reveals his/her privacy preferences and necessities, and also indirectly reflects the performance of health professionals as regards protection and maintenance of hospital privacy.